Provider Demographics
NPI:1366271991
Name:HARD KNOX BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:HARD KNOX BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCHINAL
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:740-748-0400
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-0483
Mailing Address - Country:US
Mailing Address - Phone:614-374-0530
Mailing Address - Fax:
Practice Address - Street 1:6 E. ROSS ST.
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43014
Practice Address - Country:US
Practice Address - Phone:740-748-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)